strategic physician solutions - physician advisory council

STRATEGIC PHYSICIAN SOLUTIONS™

Coors Healthcare Solutions

Challenges

• [Physician satisfaction scores]• [Physician retention]• [Profitability of physician practices]• [Physician recruitment ]• [High use/costs of Locums]

Program Objectives• Physician Advisory Council (PAC)™ to develop foundation

of communication between administration and physicians

• Develop alignment options (MSO, Co-management, etc.)

• Physician recruitment and retention training through Coors Right Hire™

Organizational Strategy

Needs Assessment / Gap Analysis

Physician Strategy

Physician AlignmentContracts,

Compensation & Implementation

Physician Recruitment &

Retention

Physician Integration

Strategic Physician Solutions™

DATA SUPPORTING THE NEED FOR INCREASED PHYSICIAN

ALIGNMENT

Alignment Drivers – National Perspective

• Physician Drivers:– Reimbursement– Health Reform– Administrative Complexity– Recruitment– Concern for Future

Referrals

• Hospital Drivers:– Clinical Integration– Health Reform– Fear of Market Share Loss– Competition – Hospital Based

Reimbursement

0 10 20 30 40 50 60 70 80

Orthopaedics

General Surgery

Cardiology

Hospitalists

Primary Care

Hospitals With MD Employment Plans: Top 5 Areas Over Next 3 Years

Healthcare Integration Trend

Source: HealthLeaders “Physician Alignment in an Era of Change” September 2010

Healthcare Integration Trend

Source: MGMA Connexion “Medical Practice Today” July 2011

Top Considerations For Doctors• Alignment of Model Options• Health System Motivations• Referral Sources• Financial• Governance, Term and Exit Strategy• Health Care Reform

WORRY MOST CONCERNING SOMEWHAT CONCERNING LEAST CONCERNING

2011 2008 2011 2008 2011 2008

Availability of Free Time 48% 33% 45% 46% 7% 22%

Dealing with Payors 42% 13% 45% 44% 13% 43%

Earning a Good Income 41% 38% 47% 45% 12% 18%

Malpractice 40% 32% 44% 37% 16% 31%

Health System Reform 39% N/A 47% N/A 14% N/A

Educational Debt 30% 60% 36% 14% 34% 27%

Ability to Find a Practice 24% 41% 34% 38% 42% 21%

Insufficient Practice Management Knowledge 22% 4% 57% 47% 21% 49%

Insufficient Medical Knowledge 7% 30% 25% 24% 68% 46%

Dealing with Patients 2% 4% 15% 35% 83% 42%

What Worries First-time Doctors

Source: 2011 Survey of Final-Year Medical Residents, Merritt Hawkins & Associates, Oct. 5

MUST-HAVE MOST IMPORTANT SOMEWHAT IMPORTANT LEAST IMPORTANT

2011 2008 2011 2008 2011 2008

Geographic Location 81% 57% 19% 12% 0% 31%

Adequate Call/Coverage/Personal Time 68% 28% 31% 53% 1% 19%

Lifestyle 64% N/A 34% N/A 2% N/A

Good Financial Package 56% 46% 42% 41% 2% 13%

Proximity to Family 52% 30% 35% 37% 13% 33%

Good Medical Facilities/Equipment 44% 23% 51% 43% 5% 34%

Specialty Support 31% 17% 54% 51% 15% 32%

Low Malpractice Area 16% 33% 58% 31% 26% 36%

Education Loan Forgiveness 12% 42% 38% 24% 50% 34%

Location Tops List Of Must-haves

COMMUNITY POPULATION 2011 2001

10,000 or less <1% 0%

10,001 – 25,000 4% 8%

25,001 – 50,000 2% 13%

50,001 – 100,000 10% 21%

100,001 – 250,000 15% 15%

250,001 – 500,000 21% 25%

500,001 – 1 million 20% 12%

More than 1 million 28% 6%

More Prefer Major Metro Areas

Physician Alignment: Due Diligence / Required Evidence • Financial Performance

• Key Financial and Operating Indicators

• Care Statistics• Quality Indicators

• Compliance • Coding Compliance program

• Character • Personal History

• Succession Planning• Ages/Demographic Group

• Malpractice Record• Past/Current Malpractice Action• Tail Coverage

• Physician Office• Location• Operational Issues

• Quality and Productivity• Mission/Patient Service• Physician Compensation and

Productivity Analysis

PHYSICIAN ALIGNMENT TOOLS

Featuring the PAC™

Physician Alignment Goals

1. Development of Physician Advisory Council (PAC)™

2. Engage Medical Staff

3. Physician/Hospital Alignment Options

Physician Engagement

• Getting Physicians’ Participation

• Getting Physicians’ Attention

• Getting Physicians’ Commitment

Physician Engagement – Built Not Bought

Goal 1: Physician Advisory Council (PAC)™

• Implementation of full program

• Creating a partnership between hospital administration and medical staff

• Increasing communication and promoting transparency to build trust

PAC™ Philosophy

• Physicians are a hospital's number #1 customer!

• This philosophy is the foundation to create a Physician-centric customer service model

PAC™ Design• TRANSPARENT COMMUNICATION – Open atmosphere• SEAT AT THE TABLE – Physician and decision makers• DIRECT INPUT TO CEO - Input for decisions effecting

physicians and patient care• OPEN FORUM – Early discussion with Physicians –

avoiding crisis• ALIGNMENT with Strategic Needs – Physician alignment

with Organization’s strategic needs

Benefits of the PAC™ • PAC™ members create a who’s who buzz among the

medical community• Informal dialogue between P.A.C. members and the

medical community circulates fresh feedback, ideas, issues or concerns

• Monthly meeting notes create tangible evidence of progress on known issues and circulates positive feedback

• Overall improved physician satisfaction and relationships

PAC™ Structure

P.A.C.™AdministrationMedical

StaffCommunication

• Successfully aligns current physicians with the strategic needs of the organization

• Establishes the groundwork for the assimilation of new physicians coming into the organization

• The PAC™ is not designed to assume or disrupt any functions of the MEC or other committees of the medical staff such as:– Peer Review – Credentialing – Quality assurance/CQI functions – Writing changes in bylaws

• PAC™ strategically aligns and strengthens the existing medical community

PAC™ - An Alignment Tool

PAC™ Wins! Mercy Hospital Mt. Airy2006 – Physician Perception of “Excellence” Percentile Rankings

2010 – Physician Perception of “Excellence” Percentile Rankings

PAC™ Wins! Northwest Medical Center

• Developed a strategic Master Plan that ensured "vested constituencies"

• Developed a 5 year Physician recruitment plan (successfully recruited 23 physicians with one year)

• Increased Patient satisfaction from 4th quartile to 1st quartile and maintained that quartile for years until company was sold

• Increased admissions by 14% Open Heart Surgeries 72% O/P Surgeries 30% Cardiac Cath 58%

PAC™ Wins! Gateway Regional Medical Center

• Developed a 5 year Master plan that charted the hospitals course for becoming Surgical and cardiac based hospital verses Psychiatric

• Grew cardiac business 60% in 2012 opening hospital's first cardiac cath lab in 2011

• Established robotic surgery program (daVinci) First year did over 140 robotic surgeries

• Increased Physician satisfaction from 34% very satisfied in 2011 to 54% very satisfied in 2012

• Developed a Geriatric Hospitalist program decreased readmissions by 20% in 4 months

• Successfully recruited 22 physicians as part of the succession plan without cannibalizing existing medical staff.

Goal 2: Engage Medical Staff

• Engage medical staff to increase physician satisfaction & communication

• Set attainable goals for physician satisfaction scores based on national averages / best practices

• Create a positive medical staff environment• Increase quality patient outcomes

Building Physician EngagementFive questions to build more powerful physician engagement:

1. What do you want your physicians to do? Physicians will be more highly engaged when they are actively included on the substantive issues

2. Do they know how to do the work?Physicians are problem solvers on steroids

3. Do they have the resources to do the work? CEOs must demonstrate that leadership and strategic work are legitimate and important parts of physicians’ jobs

4. Are physicians motivated to do the work?Many capable physicians avoid taking on the leadership work

5. How will CEOs know they have been effective?Being clear about the positive impact of better physician engagement in the change process is a critical step in shaping the message to physicians

Goal 3: Alignment OptionsEmployment Business Services Contracts

Physician Compensation/ Productivity Models

Single-Specialty Group Multi-Specialty Group Physician Network

Development

Management Services Organization (MSO)

Practice Leasing / Enterprise Model

Lease / Real Estate Contracts

I.T. Infrastructure Payor Contracting

Organizations Clinical Integration /

Physician Networks

Physician Recruitment Call pay arrangements Medical Directorships Clinical Co-

management Arrangements

Professional Services Agreements

Joint Ventures Practice Leasing

Blueprint For MSO Development

• Business Development– Central Business Office

(CBO)– Clinical Services

• Physician Development– Practice Management– Practice Operations– Regulatory and

Compliance

• Contract Management • Data Management

– Facilities Management– Financial Management – Human Resources– It Support– Marketing

• Benefits of this arrangement: – Hospital agrees to operate the practice at a fixed percentage of

collections; both parties incentivized to produce results– No capital expenditures required– Hospital benefits from stronger alignment with physicians in a less

formal manner than employment– Physicians preserve the private practice model and autonomy– Physicians can achieve balance of security and independence– Should the venture become unsatisfactory or unsuccessful, the

arrangement is much easier to unwind than a practice acquisition

The Physician Enterprise Model: A Non-Employment Alternative

Illustration:

Clinical Co-Management• Service line partnerships between hospitals and

physicians• Align hospital / physician incentives to achieve improved

patient outcomes with greater efficiency and lower costs• Allows hospital flexibility to utilize employed or

independent physician groups• Typical co-management service lines: Cardiology,

Orthopedics, General Surgical

Licensing Arrangements Coding Compliance Program Revenue Cycle Management Billing/Collections Services Practice Compliance and Integrity Programs Physician Practice Start-Up Services Comprehensive Physician Practice

Assessment/Business Plan Medical Practice Valuation

Standardized Policy/Procedure Development Educational Programs Quality Standards/Benchmarking Fair Market Value Opinion Letters Physician Contract Compliance Program Interim Management Advisory Management Services Management Mentoring Program

Value Added Physician Services

Med Auxilium™Physician Recruitment & Retention

A BLUEPRINT FOR SUCCESSFUL PHYSICIAN RECRUITMENT

Get Your House In Order: Build Your Foundation

Organizational Strategy

Community Need Analysis

Proof: Support for Road Map

Needs Assess /

GAPPrioritize

Practice Viability &

Due Diligence

Develop Road Map

Physician Strategy

PAC™

Engage Medical Staff

Transparency = Trust

Alignment Structure Options

Physician Alignment

Standardized Contracts

Performance Incentives

Create Compensation

Equality

Contracts &

Compen-sation

Coors Med Auxilium™

Physician

Recruitment & Retention

Training

Med Auxilium™ Program GoalsRobust turn-key approach brings the physician recruitment process in-house:• Assessment of existing recruitment practices and department• Sets Standardized Process• Develops strong communication skills• Developing relationships and tools – Cure for the Chaos to create a

funnel for Residents / Fellows• Development of recruitment strategy – goals, process, performance

measures• Full 12-month training and mentoring of recruitment team and

leadership for effective implementation• Determine practice setup and on-boarding• Retention strategies for continued success

Med Auxilium™ Program With Toolbox

• Customized based on organizational strategy, goals, existing structure and scope

End Goal of Full System

• Manage employed physicians– Operations improvement– Coding compliance program– Revenue cycle management– Practice compliance & integrity programs– Develop Primary Care feeder programs

• Involve physicians in measuring quality goals• Clinical Integration, Co-Management, IT infrastructure

STRATEGIC PROGRAM IMPLEMENTATION

Targeted Goals

Proposed Action Plan• Review Needs Assessment• Implement PAC™• Interview Medical Staff• Review Alignment Best Options• Med Auxilium™ Program Implementation

www.CoorsHealthcareSolutions.com1.800.507.6917

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